Outline

Introduction: Long-term ventilation in intensive care units is associated with several problems such as increased mortality, increased rates of ventilator associated pneumonia (VAP), prolonged time of hospitalization, and thus, leads to enormous financial consequences. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient’s mortality is still controversial. The aim of our study is to investigate whether early tracheostomy improved outcome in critically ill patients.

Materials and methods: Within 2 years, 100 critically ill, predominantly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy (PDT) was performed either early (Â£ 4 days, 2.8 days median) or late (Â³ 6 days, 8.1 days median) after intubation.

Results: We could demonstrate that mortality was not significantly reduced in the early tracheostomy (ET) group in contrast with the late tracheostomy (LT) group. But ET is associated with decreased VAP incidence (ET 38% vs. LT 64%), decreased duration of ventilation (ET 367.5 h vs LT 507.5 h) and shorter time of hospitalization both in hospital (ET 31.5 days vs LT 68 days) and on ICU (ET 21.5 days vs LT 27 days).

Conclusion: Despite of many advantages like reduced time of ventilation and hospitalization early tracheostomy is not associated with decreased mortality in critically-ill patients.